Fillable OT Supplemental Forms 2020 21 (Sage Colleges)

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OT Supplemental Forms 2020 21 (Sage Colleges)

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CAMPUSES IN ALBANY AND TROY | SAGE.EDU/ADMISSION
School of Health Sciences
Occupational Therapy Program
Supplemental Forms
2
SAGE.EDU/ADMISSION
Occupational Therapy Program | Application Instructions
In addition to the information provided in the general application instructions, please note the following Occupational Therapy
Program guidelines:
1.
Rolling Admissions Application Deadlines:
» The Occupational Therapy Master of OT or the Doctor of OT application priority deadline is February 1.
» The Occupational Therapy Master of OT or the Doctor of OT articulation agreement applicant deadline is June 1 of year preceding
graduation.
2.
Program Specific Instructions:
In addition to completing the General Application forms, the following programs have program-specific application
requirements: Occupational Therapy applicants please submit these forms to: graduate@sage.edu
» Select (may select both) ____ MSOT ____OTD
» Occupational Therapy Academic Standards Statement
» Clinical Observation Hours Form (Multiple copies of this form can be submitted, please see alternative activities during COVID-19))
» Prerequisite Form
Occupational Therapy applicants applying through one of the Sage Graduate School articulation agreements:
» Need to submit two (2) letter of reference (one from an academic professor, one other) and a personal statement.
» OTD Applicants: complete an additional personal essay supporting the applicant’s rationale to move to the OTD as a degree, and
complete an interview with Program Faculty, including the program director and at least one member of the OT admissions committee.
All other applicants for School of Health Science programs need only to complete and submit the SGS General Application Forms.
3
SAGE.EDU/ADMISSION
Occupational Therapy Program | Academic Standards
Statement
(Return this form to graduate@sage.edu)
Name:
Last First M.I.
Home Address:
Home Tel #:
E-mail address:
To: Program in Occupational Therapy
I wish to apply to the Occupational Therapy Program. I am aware of the criteria I must meet each year in order to maintain my status as an
Occupational Therapy major and to be eligible for continuation in the professional program.
I understand I must achieve a grade of “C” or better in all professional courses (OTH), and an overall 3.0 grade point average. Should I
achieve a grade of “C” in multiple professional courses, I understand I may be required to repeat courses or complete other remedial work to
assure competence for clinical practice. I agree to these requirements and understand that failure to do so could result in my dismissal from
the program.
I understand that I must demonstrate effective interpersonal communication skills and judgment to remain in good standing and in
order to participate in the fieldwork education component of the program. I agree to maintain these standards at all times. I
understand that faculty retains the final decision to approve students for fieldwork placements.
The occupational therapy education process includes multiple fieldwork experiences. I understand students are responsible for
transportation arrangements to and from fieldwork settings. I also understand that I am responsible for obtaining yearly physical
examinations, immunizations, and cardio-pulmonary resuscitation (CPR) certification in order to complete my fieldwork experiences.
In addition, fieldwork settings require students to be fingerprinted and undergo a criminal history review. I understand students are
responsible for the costs of these processes.
I understand that I must be continuously matriculated in the program. In the event a leave of absence is required, this must be
requested and approved by Occupational Therapy Program Faculty in order for the student to maintain a place in the program and
eventually be eligible to graduate. A formal leave of absence must also be filed through appropriate college offices (see college
catalogue for more information).
I understand that it is my responsibility to review the additions and amendments to the Occupational Therapy Handbook on an annual
basis while a member of the program.
Signature: Date:
4
SAGE.EDU/ADMISSION
Occupational Therapy Program | Prerequisite Form
(Return this form to graduate@sage.edu)
Name of student:
Last First M.I.
Indicate anticipated entry date to the Occupational Therapy Program (August 20X X):
Program Prerequisite Record
For each prerequisite courses and/or activity listed below, please indicate the timeframe during which they have been completed, are
in progress, or the anticipated date of completion. For completed coursework, indicate the grade received.
Anatomy &
Physiology
I
w
/
L
a
b
If complete If not complete
Grade
Se
m
e
s
t
e
r
/
Y
e
a
r
completed
School attended
Se
m
e
s
t
e
r
/
Y
e
a
r
of anticipated
completion
School to be completed at
Anatomy &
Physiology
II
w
/
L
a
b
Physics
I
w
/
L
a
b
(recommended)
Introduction to
Psychology
Human
Development
Abnormal
Psychology
Statistics
Sociology or
Anthropology
Medical Terminology
(Recommended)
Clinical
Observation Hours
Additional comments:
Signature: Date:
5
SAGE.EDU/ADMISSION
Occupational Therapy Program | Clinical Observation Sheet
(Return this form to graduate@sage.edu )
The Sage Colleges Program in Occupational Therapy requires that each of our Occupational Therapy Students observe or assist as a clinical
volunteer under the direction of an Occupational Therapist for a minimum of 20 hours for the MSOT and 40 hours for the OTD. We
believe that this time helps provide prospective students with a realistic perspective of the clinical aspects of therapy that are essential to their
academic success.
Please have the licensed Occupational Therapist complete this form and rating scale and return it to graduate@sage.edu
by February 1 (or
sooner for application completion). If your hours of clinical observation will not be completed at the time of application, please indicate
the anticipated date of completion in a letter. Multiple copies of this form can be made if observation hours will be completed at more
than one site. Thank you.
Name of student
Name of clinical facility
Name of Occupational Therapist (print please)
Address
Total hours spent at your facility
In what capacity?
Observation
Volunteer
Other (explain)
Please rate the student in each of the following areas:
1 | Below Average 2 | Average 3 | Above Average 4 | Superior
Relates to patients
1
2
3
4
Reliable/dependable
1
2
3
4
Relates to staff
1
2 3
4
Judgment
1
2 3
4
Accepts direction
1
2 3
4
Initiative
1
2 3
4
Carries out instruction
1
2 3
4
Maturity
1
2 3
4
Verbal communication
1
2 3
4
Appearance, hygiene
1
2 3
4
Written communication
1
2 3
4
Professional potential
1
2 3
4
Grasp theoretical concepts
1
2
3
4
I
n
te
r
e
s
t
/
mo
t
iv
at
i
on
1
2
3
4
Additional comments:
Please indicate here and on the back of this form reasons that you believe the applicant will be an asset to the Occupational Therapy Profession.
Signature
I
n
s
t
i
t
u
t
i
on
/
D
ep
a
rtm
en
t
Therapist’s Title Date
click to sign
signature
click to edit
6
SAGE.EDU/ADMISSION
FOR OT
D APPLICANTS ONLY:
Please complete a clear and concise personal essay supporting the applicant’s rationale to pursue the OTD as a degree with
careful attention to your desired doctoral capstone experience. The doctoral capstone is a 14-week practicum experience
in an advanced area of learning that occurs separate from your level II fieldwork experiences. Consider a topic area you
may be interested in in any of the following areas of occupational therapy: clinical practice skills, research skills,
administration, leadership, program and policy development, advocacy, education or theory development.
6
SAGE.EDU/ADMISSION
6
SAGE.EDU/ADMISSION
OFFICE OF ADMISSION
graduate@sage.edu
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Completed 1 February 2021

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